Provider Demographics
NPI:1568096345
Name:TERRELL, TIFFANY BROOKE (RBT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:BROOKE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SW 121ST PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4910
Mailing Address - Country:US
Mailing Address - Phone:405-550-6776
Mailing Address - Fax:
Practice Address - Street 1:1018 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6543
Practice Address - Country:US
Practice Address - Phone:405-310-5306
Practice Address - Fax:405-310-4934
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRBT-20-114313106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician